Tracking Toward Zero: Implementing A Picc Team Tracker To Prevent Clabsis, Christian Justin Carreon

Master's Projects and Capstones

Problem: Central line-associated bloodstream infections (CLABSIs) remain a significant and preventable patient safety concern in acute care settings, contributing to increased morbidity, mortality, prolonged hospitalization, and substantial healthcare costs.

Context: At Hospital A, a tertiary referral center in Northern California, six adult CLABSIs were identified between June and December 2025 following an eight-month CLABSI-free period. Four events occurred in adult medical surgical telemetry. All peripherally inserted central catheter (PICC) line CLABSIs were attributed to gaps in maintenance bundle adherence and the lack of a standardized, real-time tracking mechanism for the PICC Team.

Interventions: A PICC Team Tracker was implemented as …

Closing The Loop: Strengthening Cauti Prevention With Urinary Catheter Management, Erika N. Braun

Master's Projects and Capstones

Objective: Catheter-associated urinary tract infections (CAUTIs) are among the most common preventable healthcare-associated infections and are associated with significant patient harm and increased healthcare costs. Baseline assessment across five adult cardiovascular and critical care units within a community-based acute care hospital identified four CAUTI events during the first half of 2026 and revealed important nursing knowledge deficits related to bladder scanning protocols and urinary catheter management practices. Aim: This Quality Improvement (QI) Project aimed to improve nursing knowledge of evidence-based bladder scanning protocols and urinary catheter management practices through targeted educational interventions implemented over a 10-week period, with …

You Haven’T Been Forgotten: Driving Improvements In Trust, Transparency, And Accountability Through A Patient-Centered Communication Initiative In The Emergency Department, Ellie Mead

Master's Projects and Capstones

Objective: In Spring 2026, the Emergency Department (ED) at Hospital X identified difficulties securing high levels of patient satisfaction. Over one third of patients did not feel adequately “informed about delays,” and observation of nurse-patient interactions in front-end care areas confirmed these communication gaps: in 87% of interactions, nurses did not explain next steps to the patient, and in none of the 51 interactions observed did nurses proactively inform patients about possible delays. Aim: This quality improvement initiative sought to improve the patient experience in the ED and drive a 10% increase in Press Ganey patient satisfaction survey results relating …

Confidence Versus Competence: Addressing Nursing Knowledge Gaps In Catheter Care To Reduce Catheter-Associated Urinary Tract Infections, Leslie Anne Villanueva Bautista

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most prevalent and preventable healthcare-associated infections (HAIs), contributing substantially to patient morbidity, mortality, prolonged hospitalization, and healthcare expenditures. Most hospital-acquired UTIs are related to urinary catheters, and this burden costs the United States alone an estimated $340 to $450 million annually (Yang et al., 2022). CAUTIs are UTIs that occur in patients with indwelling urinary catheters. This quality improvement project aimed to increase adherence to existing bladder scanning protocols and strengthen urinary catheter care to prevent CAUTI. Baseline staff nurse knowledge was obtained, and reinterpretation of the facility’s existing protocols and bundles …

Draining The Risk, Holding The Line: A Nurse-Driven Approach To Catheter-Associated Urinary Tract Infection Prevention, Thy Nguyen

Master's Projects and Capstones

Catheter-associated urinary tract infections (CAUTIs) remain among the most common preventable healthcare-associated infections, with CMS eliminating reimbursement for hospital-acquired cases since 2008. Within a five-unit, high-acuity microsystem at an urban acute care hospital, four CAUTIs were documented between January and July 2026 despite established prevention protocols. Adherence gaps were identified in catheter necessity assessment, maintenance practices, and nurse-driven removal protocol use. This quality improvement project was guided by the Johns Hopkins Evidence-Based Practice framework and Lewin's Change Theory. A targeted nursing education intervention addressing bladder scanning, dependent loop identification, and catheter care bundle adherence was implemented across the microsystem over …

Reducing Catheter-Associated Urinary Tract Infections In Progressive Care, Kelli S. Bylsma

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Catheter-associated urinary tract infections (CAUTI) harm patients and increase healthcare costs. In fiscal year 2025, the progressive care unit reported a CAUTI rate 2.5 times the National Healthcare Safety Network benchmark of 1.0 infection per 1,000 catheter days. A gap analysis revealed that the project site lacked a policy mandating chlorhexidine baths for catheterized patients, resulting in suboptimal catheter hygiene and ineffective bactericidal intervention.

Aim of the Project: The aim of the quality improvement project was to reduce CAUTI rates by 50% through daily chlorhexidine baths for catheterized patients in the progressive care unit.

Review of the Evidence: Recent …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Evaluation Of Spontaneous Awakening And Breathing Trials Prior To Mechanical Ventilator Extubation To Enhance Intensive Care Unit Liberation, Shelby Taranto

Doctoral Projects

Spontaneous Awakening and Breathing Trials (SAT/SBT) might be central to early extubation by decreasing total ventilator time and reducing the intensive care unit (ICU) length of stay (LOS). Unfortunately, these trials often have not been conducted consistently in the ICU. The purpose of this research was to evaluate the frequency of SAT/SBT performed prior to mechanical ventilator extubation on total ventilator time in hours and LOS. Quality improvement aims were: (1) to ascertain if an extubation readiness tool could be easily followed and documented, and (2) to evaluate if an extubation readiness tool would add value in clinical practice. A …

Headset To Reset: Virtual Reality Therapy In Postoperative Heart And Lung Transplant Patients, Michaela Sanchez

Doctoral Projects

Postoperative heart, lung, and heart-lung transplant recipients are at increased risk for anxiety and depression, both of which have been associated with increased risk of complications and higher mortality rates. The purpose of this quality improvement project was to implement a mindfulness-based virtual reality (VR) therapy intervention for postoperative transplant recipients at a Northern California academic medical center and to evaluate its feasibility, tolerability, and acceptability during the index hospitalization. Over a 15-week period, five participants completed a total of eight VR sessions. Participants selected from immersive mindfulness-based environments, including guided meditation and other relaxation experiences. Anxiety and depression were …

Increasing Near-Miss Reporting: An Evidence-Based Approach, Rosalud H. Sanchez-Lozada

Doctoral Projects

Near-miss events, defined as errors intercepted before reaching the patient, offer valuable opportunities for learning and prevention, particularly in high-acuity intensive care units (ICUs). Despite the availability of electronic reporting systems and national emphasis on patient safety, near-miss reporting remains inconsistent in many critical care settings. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the impact of a structured educational intervention on near-miss reporting within a cardiovascular intensive care unit (CVICU) at a large academic medical center. A single-group pre–post design was used to examine changes in reporting trends following a three-week intervention that included staff education, leadership …

Implementation Of A Nurse-Driven Early Mobility Algorithm In Critically Ill Adults, Andrea Saito

Doctoral Projects

Background: Early mobilization of critically ill patients is recommended in clinical practice guidelines to mitigate ICU-acquired weakness, delirium, and improve recovery. This intervention is inconsistently implemented in many health systems due to a variety of barriers. One frequent barrier is uncertainty regarding whether patients meet safety criteria for mobilization. Purpose: The purpose of this quality improvement project was to implement a nurse-driven early-mobility algorithm with a clinical safety screen in an adult medical-surgical ICU and evaluate its impact on patient mobility scores, delirium rates, and ICU length of stay.​ Methods: The intervention was evaluated using a quasi-experimental before and after …

Weighted Blankets: Implementation Of A Quality Improvement Pilot Project In The Neurosciences Intensive Care Unit, Anita Musafar

Doctoral Projects

The weighted blanket quality improvement pilot project was implemented at Stanford Healthcare (SHC) to address the limited number of nonpharmacological interventions available for agitation management in the critical care setting. Patients within the Neurosciences ICU (NSICU) at SHC are clinically complex and uniquely vulnerable to experiencing agitation. The objectives of this initiative were to understand nurses' perceptions surrounding weighted blanket use in the critical care setting and assess whether there was a decrease in Richmond Agitation-Sedation Scale (RASS) scores with this intervention. From September 2025 to December 2025, the nurses within the NSICU implemented the use of weighted blankets for …

Improving Appropriate Nephrology Referrals Using Epic Screening Tools And Nurse Practitioner (Np) Education, Diahann M. Volcy

Seton Hall University Dissertations and Theses (ETDs)

Nephrology referral has been recognized as a modifiable factor influencing patient outcomes (Cheng, 2025). This project aims to reduce delayed or missed CKD diagnoses at large suburban hospitals in north New Jersey by improving timely nephrology referrals. I used a mixed-methods approach, retrospective chart review, pre- and post-education surveys, and referral trend analysis to assess how an educational session affects nurse practitioner knowledge and nephrology referral behavior. Enhancing nurse practitioner (NP) awareness and decision tool usage may increase early kidney care for patients, leading to better outcomes (ISN-KDIGO, 2021; Van Mil et al., 2024).

A Quality Improvement Project: The Implementation Of A Nurse Driven Morbidity And Mortality Review In An Emergency Department Setting, Abby Beutel

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Background: Morbidity and mortality reviews/conferences (MMR) are a mandatory curriculum requirement for medical residency programs throughout the United States to identify and reduce medical errors. Only within the past few decades have hospital organizations expanded MMRs to multidisciplinary teams to include medical professionals who are rendering care at the bedside more than medical providers.

Purpose: This quality improvement (QI) project focuses on the application of a nurse drive MMR amongst emergency department (ED) nurses in a community hospital in Northern Bergen County, New Jersey. This ED nurse driven MMR measured the ED nurse’s knowledge and confidence levels as it …

Implementing A Buddy System To Enhance Float Pool Nurses’ Experience And Unit Integration, Nancy Kairia

Doctoral Projects

Float pool nurses play a vital role in maintaining hospital operations; however, they often experience role ambiguity, inconsistent integration, and reduced psychosocial empowerment, which may negatively influence engagement and retention. This Doctor of Nursing Practice project implemented and evaluated a structured buddy program designed to enhance psychological empowerment among float pool nurses in a large academic medical center. Guided by Gretchen Spreitzer’s Psychological Empowerment Framework, the project examined changes across four domains: meaning, competence, self-determination, and impact. A pre-post design was used to assess outcomes before and after implementation. Five nurses completed the preintervention survey; of these, four completed the …

Measuring Effectiveness Of A Mobility Aide On A Medical-Surgical Unit, Jamie L. Granatowicz, Laura N. Rogers, Leeza A. Struwe

Doctor of Nursing Practice Projects: College of Nursing

Purpose: To evaluate the effectiveness of a mobility aide on a medical-surgical inpatient unit to improve patients’ surgical outcomes, decrease hospital length of stay, and decrease the number of falls.

Design: A retrospective review was conducted to determine the effects of a mobility aide implemented on a medical-surgical unit. The intent was to ensure the utilization of the Enhanced Recovery After Surgery (ERAS) protocol for early mobilization before and after implementation. Two-month periods were analyzed before and after implementation.

Findings: The results demonstrated clinical significance for patients when implementing a mobility aide. The mean length of stay was 1.044 days …

Heads Up! Designing A Nursing Assessment Tool For Early Recognition Of Intracranial Hypertension Post Head Injury, Sergio A. Dondiego

Honors Capstones

This meta-analysis identifies noninvasive clinical predictors of intracranial hypertension (IH) post head trauma to develop a multi-criteria IH screening tool designed for nurses to wear on their badge reels. High-sensitivity predictors were prioritized to assist in early IH suspicion. Findings suggest that radiographic-measured abnormalities including an optic nerve sheath diameter (ONSD) 5.6 mm and signs of significant head trauma via computed tomography (CT) were highly effective for predicting IH and were therefore defined as major criteria for the assessment tool. Other significant examination findings include a Glasgow Coma Scale (GCS) score 8 and atypical pupillary reactivity. While age showed conflicting …

The Relationship Between Mc1r Gene Variants For Red Hair And Clinical Responses To Anesthesia, Analgesia, And Pain: A Systematic Review Of The Literature, Mary Clark Allen

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Genetic variations of the melanocortin-1 receptor (MC1R) are commonly associated with red hair and pale skin. Research has linked MC1R variants with alterations in anesthetic response, pain perception, opioid sensitivity, and pain-related fear. Existing literature presents inconclusive findings, highlighting the need for further investigation.

Purpose: This review aims to synthesize current evidence concerning the role of MC1R variants in altering physiologic responses.

Methods: A systematic literature review was conducted by accessing CINAHL, MEDLINE, and PubMed through the University of Arkansas Libraries OneSearch platform. After applying inclusion and exclusion criteria, a total of 20 peer-reviewed articles were extracted for review. …

A Pilot Project On Improving Icu Nurses’ Confidence In Early Defibrillation, Adetutu Obadina

Doctoral Projects

Early recognition of shockable cardiac rhythms and timely defibrillation are critical components of effective resuscitation during in-hospital cardiac arrest. Despite established guidelines from the American Heart Association (AHA), nurses may experience uncertainty or reduced confidence when identifying shockable rhythms and delivering timely defibrillation during cardiac arrest events. The purpose of this project was to examine whether a structured educational intervention incorporating simulation-based training could improve intensive care unit (ICU) nurses’ confidence and knowledge in recognizing shockable rhythms and performing timely defibrillation. A pre-and post-intervention design was implemented among ICU nurses at a large academic medical center between September and October …

Early Pressure Injury Identification And Intervention In Emergency Department Older Adults Who Are Admitted Into A Community Hospital Intensive Care Unit, Lisa M. Britt

Doctor of Nursing Practice (DNP) Scholarly Projects

A clinical gap was identified when reviewing a hospital acquired pressure injury (HAPI) dashboard from a 369- bed, acute care community hospital located in North Texas. Fifty percent of HAPIs acquired occurred in older adults, aged 60 or higher, who were admitted into the intensive care unit (ICU) from the emergency department (ED). A retrospective review of the electronic health records (EHR) demonstrated that none of the patients had received HAPI prevention interventions while they were in the ED and the inconsistent document of skin assessments resulted in identification of few HAPIs present on admission (POA). The purpose of this …

Improving Nurse Confidence And Patient Safety Through Timely Nonpharmacologic Delirium Prevention Interventions: A Quality Improvement Project, Claire E. Mccabe

Master's Theses and Capstones

Abstract

Background

Delirium prevention is an ongoing patient safety priority within a Medical Intensive Care Unit (MICU) because delirium contributes to preventable patient harm, including unplanned device removal, prolonged mechanical ventilation, falls, increased mortality, and long-term cognitive impairment. Key signs of delirium include fluctuating awareness, severe confusion, disorganized thinking, and difficulty focusing. Although the ABCDEF bundle is established within the local MICU, an implementation gap remained in consistently integrating nonpharmacologic prevention strategies into routine nursing workflows.

Methods

The purpose of this quality improvement project was to improve nurse confidence, awareness of workflow opportunities, and implementation of evidence-based delirium prevention interventions …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Decreasing Hospital Acquired Pressure Injuries Through A Multi-Intervention Approach: A Quality Improvement Project, Kendra D. Crawford

DNP Scholarly Projects

BACKGROUND: Hospital acquired pressure injuries (HAPIs) continue to plague hospitals across the country. HAPIs are an indication of the quality of care delivered by the hospital’s nursing workforce. These injuries are costly to organizations and can lead to increased length of stay (LOS). The development of a HAPI, depending on severity, is a reportable injury and is classified as patient harm. Patients who suffer from HAPIs can experience significant pain and at times, permanent disfigurement. This project’s focus is a community hospital that has seen a steady increase in HAPIs over the last 2 years. During 2025, 28% of the …

Patient Safety: Paramedic To Nurse Patient Handover Quality And Its Influence On Clinical Deterioration In The Emergency Department, Madison P. Penick

Nursing | Senior Theses

Background: Quality patient handoff from Emergency Medical Services to the Emergency Department is a crucial transition of care that directly impacts patient safety, medical intervention, and patient outcomes. If concise, effective communication is not achieved, critical details can be left out resulting in medical errors, delayed intervention times, and lack of identification of clinical deterioration.

Aim: This study aims to understand how paramedic to nurse handoff quality impacts a nurse’s early identification of clinical deterioration.

Proposal:

Methodology: A quasi-experimental study of mixed-method research.

Recruitment strategy: A fire department in Marin County, CA and ED nurses from the base trauma center …

Combating Pressure Injuries In Critical Care: A Dnp Project On Nursing Education And Prevention Strategies In The Icu, Tijuana M. Johnson

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) are preventable complications that significantly increase patient morbidity, mortality, length of stay, and healthcare costs, particularly in intensive care units (ICUs). At a rural 146-bed hospital, the ICU pressure injury rate of 1.17 per 1,000 discharges exceeded the national benchmark of 0.58 per 1.000 discharges, identifying a critical gap in prevention practices. This Doctor of Nursing Practice (DNP) project aimed to improve ICU nurses' knowledge of pressure injury prevention and reduce unit-based educational intervention grounded in Patricia Benner’s Novice to Expert Theory and implemented using the Plan-Do-Study-Act (PDSA) quality improvement framework.

A pre-and post-intervention design was …

Improving Staff Knowledge And Consistency In Sat And Sbt Practices In The Critical Care Unit: A Quality Improvement Initiative, Morgan Crapo

Master's Theses and Capstones

Abstract

Background: Spontaneous Awakening Trails (SATs) and Spontaneous Breathing Trials (SBTs) are key components of the ICU Liberation Bundle and have been associated with shorter durations of mechanical ventilation, reduced intensive care unit (ICU) length of stay (LOS), and improvement in patient outcomes. Despite having strong evidence supporting their use, implementation remains inconsistent due to knowledge gaps, workflow barriers and interdisciplinary communication challenges.

Local Problem: This quality improvement (QI) project aimed to improve critical care nurses’ knowledge and confidence regarding the implementation of SATs and SBTs through an evidence-based educational intervention.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, this QI …

Improving Efficiency In The Intensive Care Unit Through Reduction Of Nurse Burnout: A Quality Improvement Initiative, Johanna Grace Koroma

Master's Theses and Capstones

Abstract

Background: Intensive care unit (ICU) nursing is prone to high levels of burnout, which poses concern for staff wellbeing, patient safety, and microsystem strain (Kerlin et al., 2020). Educational interventions may serve as a means of increasing awareness on the issue and reducing the effects of burnout, through promotion of evidence-based management strategies.

Local Problem: One ICU microsystem identified several key contributing factors to nurse burnout, including staffing shortages, limited resources, competing responsibilities within the macrosystem, and insufficient organizational support (Zhang et al., 2025). Baseline survey data of the population observed a prevalence of 50% “high” burnout profiles among …

The Impact Of Night Shift On New Nurses: Effects On Mental Health And Work-Life Balance, Avery Windham, Abby Maruskin, Elizabeth Yoder

Williams Honors College, Honors Research Projects

This research examines the impact of night shift schedules on new nurses' mental health and work-life balance as they transition into professional practice. The transition from nursing school to the workforce presents challenges that are further compounded by shift work, which can disrupt circadian rhythms and contribute to stress, fatigue, and reduced job satisfaction. The purpose of this research is to evaluate how starting on night shift versus day shift influences nurses’ self-evaluation of work-life balance within their first year of practice. This systematic review synthesizes findings from peer-reviewed sources to assess the physical, emotional, and professional consequences of night …

Propofol Vs Dexmedetomidine: Impact On Reintubation And Respiratory Depression, Dominic J. Hamad, Stephanie Wodrich, Logan Campola

Williams Honors College, Honors Research Projects

This project aims to compare the effects of Dexmedetomidine and Propofol on breathing recovery in ICU patients who have been mechanically ventilated. Specifically, we want to find out whether one sedative is more likely than the other to lead to respiratory depression or reintubation after sedation is stopped. These outcomes are important because they directly affect patient safety, ICU length of stay, and overall recovery. Our team will conduct a systematic review of randomized controlled trials found through databases like PubMed, CINAHL, and Cochrane Library. We will focus on adult ICU populations and only include studies that report on relevant …

Implementation Of A Cardiomems Screening Tool To Increase Provider Awareness And Referrals In Eligible Patients, Monica Rios

DNP Projects

Background: Heart failure affects over 6 million Americans and causes more than one million hospitalizations annually. CardioMEMS, a remote pulmonary artery pressure monitoring device, effectively reduces hospitalizations, yet its use remains limited due to provider and system barriers. The purpose was to increase CardioMEMS referrals for eligible heart failure patients through targeted provider education and a standardized screening tool.

Local Problem: Kentucky experiences higher heart failure hospitalization rates than the national average, contributing to prolonged hospital stays and rising healthcare costs.

Methods: A pre—post quasi-experimental study was conducted at an academic medical center. Baseline chart review of 47 patients evaluated …